Purpose or Case Report: Neuroblastoma, the most common extracranial solid tumor in children, arises from embryonal neural crest progenitor cells. With a common origin of neuroendocrine cytology, this otherwise highly variable disease can be imaged with high sensitivity by exploiting the underlying biochemistry of the nervous system – namely with radiolabeled I-123 metaiodobenzylguanidine (MIBG), a norepinephrine analog. Imaging with MIBG over time can serve several key roles, including providing accurate stage at diagnosis, response assessment following therapy, and detection of recurrent disease. Moreover, when using the Curie score, a standardized and validated assessment of MIBG uptake on planar imaging, valuable prognostic information can be elucidated both at time of diagnosis and following induction therapy. Through the utilization of the same underlying physiologic principles, I-131 MIBG could be administered for an intended therapeutic effect, targeting sites of tracer uptake. The purpose of this educational exhibit is to review the process of quantifying and assigning a Curie score in the evaluation of pediatric neuroblastoma using I-123 MIBG planar imaging. Using a pictorial review of various I-123 MIBG positive cases, we will highlight normal MIBG uptake, distribution, and excretion. Through the inclusion of case examples that demonstrate various stages of disease, differing sites and severity of pathologic activity will be highlighted. Finally, the prognostic significance of the Curie scoring paradigm over time will be illustrated, specifically at the time of diagnosis and post-induction with I-123 MIBG, and in the post-therapy setting with I-131 MIBG.
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